AB0973 Long term efficacy of intra-articular viscosupplementation with hyaluronic acid in hip osteoarthritis secondary to systemic rheumatic diseases: a preliminary evaluation
Authors: E. Cumbo, O. De Lucia, A. Murgo, C. Artusi, R. Cimaz, R. Caporali
Journal: Annals of the Rheumatic Diseases (2022)

Background Few studies have assessed response to intra-articular HA viscosupplementation in patients affected by hip osteoarthirtis secondary to systemic rheumatic diseases (SOA). From in vitro studies we know that the synovial environment in these diseases presents different molecular characteristics in comparison to primary osteoarthritis (POA) in terms of pro-inflammatory activity and therefore in degradation of hyaluronic acid. Objectives To evaluate differences in efficacy and safety of treatment with US-guided intra-articular HA viscosupplementation between a cohort affected by POA and one affected by SOA, with regard to pain assessment and time to arthroplasty. Methods We conducted this observational retrospective study on consecutive patients treated with US-guided hip intra-articular injections with Hylan G-F 20 2 ml at the Rheumatology Unit of ASST-Pini-CTO (Milan, Italy) from 2013 to 2021. Joints with active synovitis detected by US examination weren’t treated. VAS pain at baseline and at the end of October 2021 was registered as well as time to the event of hip arthroplasty and adverse reactions. Patients treated had hip pain at least 6 months before treatment and radiological OA assessed by standard hip X-rays no more than 6 months before baseline. Patients included in the SOA group had a diagnosis of rheumatic systemic disease, POA patients had osteoarthritis and any further rheumatological condition was ruled out. Additional clinical features recorded for the SOA patients were clinimetric assessment of disease activity according to SDAI for RA, clinical judgment for PMR, DAPSA for PsA, ASDAS for SpA and medical treatment at baseline. Results We included 55 primary OA patients and 16 systemic rheumatic diseases patients (5 JIA, 5 peripheral SpA, 2 PMR, 1 Axial-Spa, 1 PsA, 2 RA) who had received hip intra-articular HA injection with Hylan G-F 20 2 ml once a month for three consecutive months and then every six month. Mean duration of follow up was 51.1 (± 27.1) months. We observed significant longer treatment survival and lower VAS pain in POA patients at follow up (in absence of significant difference of VAS pain at baseline). In both cohorts we observed a reduction in VAS pain similar to that reported in literature: in the POA a mean reduction of 29.7 (95% CI 23.8-35.6), while in the SOA was noticed a mean reduction of 12.8 (95% CI 1.8-23.7) in absence of significant clinimetric variations over time. We observed higher incidence of local adverse reactions in SOA group (2 cases of post-injection synovitis in the SOA cohort only (12.5%), p 0.04). POA Hips (N=62 ) SOA Hips (N=16 ) p-value Treatment duration, m 46.8±30.2 22.4±22.4 0.0038 HA injections, (N) 9.9±5.1 5.3±3.2 0.0011 3 or more HA injections, % (N) 85% (53) 81% (13) 0.70 Adverse reactions, % (N) 0 12.5% (2) 0.040 VAS Pain 3.25±1.73 4.3±1.4 0.029 Total Hip arthroplasty during follow up, % (N) 11.2 (7) 6.2 (1) 1.00 Time to arthroplasty, m 46.8±30.2 26 0.28 Conclusion According to our results symptomatic hip SOA patients respond less and with a slightly higher degree of adverse reactions to intra-articular viscosupplementation when compared to POA patients, even if the incidence of these adverse events was similar to that observed in previous studies. We can infere that synovial pro-inflammatory enviroment in rheumatic systemic diseases can reduce efficacy of intra-articular viscosupplementation with hyaluronic acid. References [1]Migliore Alberto et al., «Intra-Articular Injection of Hyaluronic Acid (MW 1,500–2,000 KDa; HyalOne) in Symptomatic Osteoarthritis of the Hip: A Prospective Cohort Study», Archives of Orthopaedic and Trauma Surgery 131, n. 12 (December 2011): 1677–85, https://doi.org/10.1007/s00402-011-1353-y . [2]Thierry Conrozier et al., «Clinical Response to Intra-Articular Injections of Hylan G-F 20 in Symptomatic Hip Osteoarthritis: The OMERACT-OARSI Criteria Applied to the Results of a Pilot Study», Joint Bone Spine 73, n. 6 (December 2006): 705–9, https://doi.org/10.1016/j.jbspin.2006.02.008 . Disclosure of Interests None declared